Successfully Implemented Health Information

Technology in a Rural Hospital

Case Study & Lessons Learned

Denni McColm, CIO

• Hospital – 76 Beds

• Emergency Services– Level III trauma center

• Home Health, Hospice, HME, Health Transit

• Long Term Care Facilities (5)• Residential Care Facility (1)

• Physician Clinics (25 clinics, 60 providers)

• Outpatient Services

• Ambulatory Surgery Center

• Carrie J. Babb Cancer Center

CMH Numbers

• Employees = 1,550• Service Area = 5 counties• Service Area Population =

100,000• JCAHO Accredited• Sole Community Provider• Organization

– Public Hospital District and– Non Profit Foundation

EMR across continuum * CPOE * No paper charts

1999 Strategic Planning – Seamless Care Across the Continuum

2000 IT Needs Assessment, Goals, Philosophy, Vision

2001 Vendor Selection & Implementation Approach/Plan

2002 Core Financial & Clinical Systems

2003 Physician Practice Management System, home care, LTC Financial, Hospital Nursing, CPOE, Physician Documentation (paperless in hospital)

2004 PACS, LTC Clinical (paperless in LTC)

2005 Electronic Ambulatory Record in Physician Clinics (paperless in clinics)

2006 Emergency Room & bedside medication verification with barcodes

2007 In-home tele-management (Well@Home)

2008 Speech Recognition, PACS expansion

2009 Patient Portal, Integrated vital signs monitors and glucometers, ePrescribing, Maestro

2010 GoogleHealth, Upgrade to Certified Version

Lessons Learned

• Agree on the why• Adopt an approach• Evaluate the alternatives• Be all inclusive• Document the official “go ahead”• Plan the implementation in detail• Articulate the objectives• Talk-Talk-Talk• Expect it to be hard• Physician specifics• Miscellaneous tips & tricks

Agree on the Why

• Strategic initiative– Seamless care

across the continuum

• Expressed in vision statement

Project Infocare Vision

• Enable a patient to enter anywhere into our continuum of care and have a personal identity that is maintained across that continuum

• Physicians and other caregivers will have access to all of that patient’s information within the healthcare system

• Providers will be able to document efficiently within the software system, which will free them to have more time to spend with patients

• The investment of time, talent and money will enable CMH to be a technologically advanced healthcare organization poised to grow and offer new services to our patients and the community at large

Adopt an Approach

• Guided by vision and strategic plan for CMH

• Integration strategy• Priority to system that meet

overall organization needs• Single core vendor whenever possible• Use formal process (needs, requirements,

due diligence)• Develop infrastructure to support systems

Evaluate the Alternatives

• Re-demonstrate existing systems

• Look to the market

• Scrutinize options

Be All Inclusive

• Who?– Board– C-Suite– Physicians– Clinical– Business– Support

• How?– Participate in defining needs– Demonstrations– Site visits

Communicate how

their input made a

difference

Document the Official “Go Ahead”

• Include resources– $$– People/time– Support– Broad timelines

Plan the Implementation in DetailPathfindingKey stakeholders: patients, physicians & other

caregivers, system end users, and administration & Boards

AligningTechniques and practices: understand and become experts on the system before

training, phase in functions in order to ensure sufficient resources

for support during training, implementation and post-live, build a foundation upon which an EMR can be

developed/utilized, seek process improvements in each step to enhance

workflow, identify problem people and make a positive effort to

engage them in the process, and market the project to end users throughout the continuum

of care.

ModelingThe role of the IS Steering Committee was

determined to be to allocate resources, remove obstacles, establish parameters, serve as cheerleaders, implement to maximize functionality serve as communication liaisons.

EmpoweringImplementation Teams. Key qualities to

seek in Implementation Teams include: knowledge of department or function, trusted/respected, works well with other departments, interest/enthusiasm, communicator/listener, organized/can meet deadlines, and motivated.

Articulate the Objectives

• Patients will be asked to supply information only once. • Patients will be able to schedule appointments for all services from

all locations.• Documentation will be captured at the point of care. • Charges to accounts will be created automatically as care providers

document. • CMH will give care providers easy-to-use, reliable, timely, accurate,

and complete information available from any location.• CMH will employ the new system tools to enhance patient care,

improve delivery and safety of care and support decisions with access to knowledge bases.

• CMH will phase out paper documents and select query-able data elements over scanned images.

Talk-Talk-Talk• Outbound communication / marketing

• Inbound communication / listening (active solicitation)

Expect it to be Hard

• Denial, Anger, Bargaining, Depression, Acceptance

• HIT the wall• Secure

CEO/Administrative support

• Keep on going

Physician Specifics• Use same CPOE tool house wide

• Remove hardware an excuse

• Physician resource room and support

• Protect them from zealots

• Make it personal

• Phased approach

• Go paperless

Miscellaneous Tips & Tricks

• Subject matter experts with technical aptitude = the best support team

• Extend and enhance through superusers

• Train for patient-friendly use

• Plan for quality reporting early

• Revisit the vision and objectives

• Become the tribal storyteller

In Conclusion

• Agree on the why• Adopt an approach• Evaluate the alternatives• Be all inclusive• Document the official “go ahead”• Plan the implementation in detail• Articulate the objectives• Talk-Talk-Talk• Expect it to be hard• Physician specifics• Miscellaneous tips & tricks